MEDICARE: HEALOGICS SPECIALTY PHYSICIANS OF SOUTH CAROLINA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician
3	207V00000X	Obstetrics & Gynecology Physician
4	207X00000X	Orthopaedic Surgery Physician
5	208600000X	Surgery Physician
6	363A00000X	Physician Assistant
7	363L00000X	Nurse Practitioner
8	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1033531850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALOGICS SPECIALTY PHYSICIANS OF SOUTH CAROLINA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 645743
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45264-6017
Country	:	US
Telephone Number	:	855-689-5105
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 HIGHWAY 17 BYP S
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-4500
Country	:	US
Telephone Number	:	843-839-6000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FRANK WILLIAMS
Credential	:
Telephone Number	:	904-446-3519

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	06/01/2023

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